27 Aug 2013

Healthy Body, Healthy Mind

1.          Aim

To introduce research regarding how the body and mind are inextricably linked, focusing on the effects of exercise on brain development in humans.

2.          Intended audience

The general public as it has far reaching consequences for us all. Despite an attempt to simplify the content, some understanding of basic biology and the nervous system will help. See terminology below.

3.          Terminology

a.          Neural plasticity - ability of the human brain to change as a result of one’s experiences.

b.          Neurons - nerves.

c.          Neurogenesis - development of nerve tissues.

d.          Neurotransmitter - chemical substances which enable the nerve impulses to be passed from one nerve cell to the next.

e.          Cognition - the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment.


4.          Introduction

Mens sana in corpore sano, “a healthy mind, in a healthy body” (Juvenal 1st & 2nd AD, Roman Poet), “give me the child until he is seven and I will give you the man” (St Francis Xavier 1506 - 1552). 

These two sayings have been used time and again over the centuries to mean many different things. However, I feel it is only now that their true relevance has been revealed. The relatively modern study of developmental psychology and its link to locomotion in the early phases of our lives is shedding new light on our evolution and enabling us to build strategies to combat an array of conditions. More importantly it is highlighting how we are neglecting what it is to be human; an animal that is designed to move and interact with our environment.

This blog is only the tip of the iceberg but touches on some of the key areas within this field of research and what it means for you and your children.

5.          The basics

When you are born the brain is not a finished product. It is only about 20% complete[1]. All the neurons are there, however, they are unconnected. Over the next 3 years approximately 85% of this connecting takes place and is believed to be completed between 6-8 years of age [1],[2]. The way in which these neurons link however, is completely dependent on physical and emotional experiences during these formative years [1]. You can see in Fig 1, that the synaptic connections are at their most dense around the 2 year point and then actually thin out by the time you are an adult. This is because the body actually over produces synaptic connections in the early years as it lays down the foundations for later development [2]. Following this it plateaus and then proceeds to go through a phase of “synaptic pruning” around the age of 12 - 13yrs, where by the density of these connections decreases to around 60%[2]. In essence this streamlines the brain to ensure it works efficiently.


Fig 1. Showing how the brain “wires” itself in the early years





If the brain does not receive the correct stimulus in these formative years then it can have detrimental effects on the way in which the brain “wires” itself, see Fig 2. Now you may be saying to yourself “No @*%$ Sherlock, if you deprive a child of stimulus early on then you’re going to have problems” and quite right to. But it is not that simple;

·       How much of a problem is it?
·       How easy is it to neglect the correct stimulus?
·       Can you re-wire the brain after these formative years?
·       How we can we prevent it in the first place?

The research that has been most surprising are the effects of exercise on brain development. More and more studies are showing that it is physical activity in these formative years that actually lays down the pathways for learning and higher brain functions later in life and not early introduction of “academic” style learning. The brain and body link together to explore the environment around us, so physical activity promotes the growth of our brains in a variety of areas, not just the parts concerned with movement.

Fig 2. The neglected brain





6.          Exercise and Early Neural Development.

At first there was some doubt as to the effects of exercise on the development of the brain, however, it is now widely accepted that physical activity does stimulate brain growth [2], helps to protect new neurons and improves cognition [3].

One theory put forward for the origin of this response to exercise is that it is possibly an adaptive process. In our hunter gatherer past it would certainly have been advantageous for us to engage our brains when we were foraging, i.e. improving our spatial memory and planning abilities [3]. Whatever the reason we know that our bodies and brains are designed to move through and engage with our environment. Not to sit at a desk all day and tap keys!

Studies have shown that by taking regular aerobic exercise, there are marked improvements in a child’s ability to perform in cognitive areas including perceptual skills, creativity and concentration, academic readiness, general achievement, IQ, maths and verbal tests [4]. This is supported by evidence gleaned in the classroom and in the laboratory, with neuroimaging evidence demonstrating that children with improved aerobic fitness have improved brain function and structure in general [5].

“The greatest cell proliferation in response to exercise occurs early in development, suggesting that exercise interventions may be particularly effective during early childhood” Halperin, et al (2012) [5]

Exercise or physical activity should therefore begin as early in life as possible in order to develop not only our bodies but more importantly our minds.

With regard to research on resistance training and brain function in children, there are no studies [5]. This is thought to be because of the common misbelief that children shouldn’t undertake resistance training. As such this area of study requires much attention.


7.          Exercise and Adult Neural Development.

Unlike in children aerobic training has “a selective rather than general effect on task-related brain function” [5]. This is congruent with the fact that the adult brain has a lower degree of neural plasticity [6]. In general, aerobic activity increases brain structure, brain function and cognitive performance in elderly adults [5],[6]. The effects of resistance exercise on memory/cognition, is still very much open for debate, with some studies showing positive results and some not [5]. However, it has to be said that regardless of its effects on memory without a base level of strength (i.e. the strength to get out of a chair and confidently move around) you cannot achieve aerobic fitness anyway. As such my personal feeling is that both are important for total well being, although aerobic fitness, at present, is the most documented for prevention and treatment of decreasing cognitive abilities in older adults. It is important to note that stretching and toning does not improve brain function [6]. This is significant as a large swathe of older adults who do take exercise tend to conduct activities such as pilates and yoga (which are primarily stretching and toning based). As this is also the population most at risk from degenerative brain conditions, this is an area requiring some work from those involved in this research.


8.          Conclusion

The importance of exercise in our lives has long been acknowledged but is generally seen in a slightly superficial way, namely to attain the “Body Beautiful” (what ever that is!!) or to improve only the performance of our bodies from the neck down.

To me this field of research highlights how critical physical education (P.E.), early parental engagement and exploration of the environment is for the development of our children, from the moment they arrive in this world. Instead the situation we have at present couldn’t be further from this. P.E. is being cut from school curriculums around the world, children spend more time in front of computers and infants are bought more and more “educational toys” rather than being encouraged to interact with the world around them. US statistics, for example, show that less than 50% of children aged 6-11yrs get the recommended 60min of exercise most days of the week and this figure only gets worse as they get older [5]. Then there are the societal pressures whereby parents are smothering their children in bubble wrap, so to speak, because they are either too scared of what might happen to them or too scared that other people will think they are bad parents when something does happen! The first 7 years of our children’s lives are vital to lay down the foundations of who they are and we must encourage them to interact with the environment and move their bodies in as many ways possible.

Fox, et al (2010) [8] sums it up nicely, “To borrow an analogy from economics, by investing early and well in our children’s development we increase the rate of return later in life, and in so doing improve not only the lives of individuals but of societies as well.”

In relation to the adult brain, the more we understand how to increase neural plasticity, the more we can help combat a host of degenerative conditions, improve recovery following trauma and aid conditions such as depression.

Little is known about whether or not exercise improves cognitive abilities and memory in “normal” young adults. Based on the research in this article however, I would hazard a guess that physical activity is vital in order to be a healthy, well-adjusted individual.

It truly is healthy body, healthy mind.


Regards


Gregory hunt




References



[1] Goodsport Trust Coaches Handbook, 2012. Early Development Movement p7-8

[2] Halperin J.M., Healey D.M.The Influences of Environmental Enrichment, Cognitive Enhancement, and Physical Exercise on Brain Development: Can we Alter the Developmental Trajectory of ADHD? Neurosci Biobehav Rev. 2011 January; 35(3): 621–634.


[3] Raichlen D.A., Polk J.D. Linking brains and brawn: exercise and the evolution of human neurobiology. Proc Biol Sci. 2013 January 7; 280(1750).


[4] Voss M.W., et al. Exercise, brain, and cognition across the life span J Appl Physiol. 2011 November; 111(5): 1505–1513.

[5] Halperin J.M., et al. Preventive Interventions for ADHD: A Neurodevelopmental Perspective. Neurotherapeutics. 2012 July; 9(3): 531–541


[6] Bavelier  D., et al. Removing brakes on adult brain plasticity: from molecular to behavioral interventions. J Neurosci. 2010 November 10; 30(45): 14964–14971.

[7] Bryck R.L., Fisher P.A. Training the Brain: Practical Applications of Neural Plasticity From the Intersection of Cognitive Neuroscience, Developmental Psychology, and Prevention Science. Am Psychol. 2012 February; 67(2): 87–100.

[8] Fox S.E., et al. How the Timing and Quality of Early Experiences Influence the Development of Brain Architecture. Child Dev. 2010 Jan-Feb; 81(1): 28–40.


Bibliography

Pangelinan M.M., et al. Beyond age and gender: Relationships between cortical and subcortical brain volume and cognitive-motor abilities in school-age children. Neuroimage. 2011 February 14; 54(4): 3093–3100.

Giedd J.N., et al. Anatomic Magnetic Resonance Imaging of the Developing Child and Adolescent Brain and Effects of Genetic Variation. Neuropsychol Rev. 2010 December; 20(4): 349–361.

Lipina S.J., Posner M.I. The impact of poverty on the development of brain networks. Front Hum Neurosci. 2012; 6: 238.

Hensch T.K., Bilimoria P.M.  Re-opening Windows: Manipulating Critical Periods for Brain Development. Cerebrum. 2012 Jul-Aug; 2012: 11.

Rodgers S.P., et al. Neurogenesis, Exercise, and Cognitive Late Effects of Pediatric Radiotherapy. Neural Plast. 2013; 2013: 698528.

Rao H., et al. Early Parental Care Is Important for Hippocampal Maturation: Evidence from Brain Morphology in Humans. Neuroimage. 2010 January 1; 49(1): 1144–1150.

Hyde K.L., et al. Musical Training Shapes Structural Brain Development. J Neurosci. 2009 March 11; 29(10): 3019–3025.

Cramer S.C., et al. Harnessing neuroplasticity for clinical applications. Brain. 2011 June; 134(6): 1591–1609.

Jolles D.D., Crone E.A. Training the developing brain: a neurocognitive perspective. Front Hum Neurosci. 2012; 6: 76.

Anderson D.I., et al. The role of locomotion in psychological development. Front Psychol. 2013; 4: 440.

Baker L.D., et al. Effects of Aerobic Exercise on Mild Cognitive Impairment. Arch Neurol. 2010 January; 67(1): 71–79.

Roig M., et al. A Single Bout of Exercise Improves Motor Memory. PLoS One. 2012; 7(9): e44594.

Smith P.J. et al. Aerobic Exercise and Neurocognitive Performance: a Meta-Analytic Review of Randomized Controlled Trials. Psychosom Med. 2010 April; 72(3): 239–252.

Erickson K.I., et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011 February 15; 108(7): 3017–3022.

Erickson K.I., et al. Aerobic Fitness is Associated With Hippocampal Volume in Elderly Humans. Hippocampus. 2009 October; 19(10): 1030–1039.

Ratey J.J., Loehr J.E. The positive impact of physical activity on cognition during adulthood: a review of underlying mechanisms, evidence and recommendations. Rev Neurosci. 2011;22(2):171-85.




17 Jul 2013

Does Kinesio Tape Work?

1.          Aim

To use peer reviewed journals to assess whether or not kinesio tape works better then traditional tapes, if so in what ways and in what instances should it be used.

2.          Intended Audience

The general public but also anyone involved in health and fitness. There is also assumed knowledge as to what Kinesio tape is.

3.          Introduction

Kinesio tape is not a new product, in fact it has been around for about 25 years or so[1]. Dr Kenso Kase developed the tape in the 1970’s and it has been used in Asia through out this time[2]. So why has it suddenly exploded in the last few years. The main reason was the 2008 Olympics. The tape was donated to 58 different countries1 to use on their athletes during the games, raising its profile greatly on the world stage.

The proposed benefits of the tape include improved posture, lymphatic drainage, blood flow, increased power output, improved biomechanics, decreased pain, joint support, relaxing over loaded muscles[1] [2] and generally making you an all round better individual! It’s like there is nothing this tape can’t do.

Okay the last one isn’t true but you take the point. How can this one tape do all of this? An evidence based approach to rehabilitation and training is what all those involved in the health and fitness sector should be striving for. As such I decided to look at the evidence myself, to improve my own learning on the subject and to help give other individuals an informed review.

4.          What the evidence says

Despite being around for a while the evidence regarding the kinesio tape is shaky at best. There is little of it and what can be found is of fairly low quality mainly due to poor study design or general bias [1],[3],[4]. So what does the current research conclude?

There is weak evidence to suggest there could be increased muscle activity [2]. Huang C., et al, 2011, found they could illicit greater muscle activity from the triceps surae (calf muscles), however, this didn’t translate into higher vertical jump scores. As such they conclude that there could be some benefit to rehabilitation of injuries where by the goal is to increase muscle activity, however, they added that their study was too small and did not cover a wide enough population in order to create recommendations for the general public.

Campolo M., et al, 2013, found no difference between a traditional taping method and Kinesio taping on anterior knee pain. Both techniques and materials gave pain relief but it was noted the participants had never experienced any taping before and therefore this could have been a placebo effect that was not adjusted for. In conclusion a larger, more in depth, well designed study must take place[5]. Ayatar A., et al, 2011, also found no effect on either knee function or pain for those with patellofemoral pain sydrome (pain under the knee cap)[6].

McConnell Taping [5]

Kinesio Taping [5]



Paoloni M., et al, 2011 and Castro-Sanchez A.M., et al, 2012 both investigated the effects of kinesio taping on lower back pain. Both concluded that there could be some use of Kinesio taping for rehabilitative purposes as they notice a small decrease in pain.  However, they both state that further research is needed to confirm finings. It should be noted in the case of Paolini, 2011, there was no placebo group and only focused on a sub group of those with chronic back pain (those who struggle with flexion relaxation)[7],[8].

Chang H.Y., et al, 2013, investigated the effects of Kinesio taping on medial elbow epicondylar tendinopathy (often manifested as “golfers elbow”). This time they did use a placebo group and found there was no difference at all between the groups[9].

5.          Conclusion

It would appear the old saying “if its too good to be true; it probably is” might apply here. I can’t find any scientific basis to any of the claims regarding elastic type taping. This is not to say there aren’t studies out there that do, and indeed would ask that if you know of any to bring them to my attention as I would very much like to review them. I am very much aware of the vast amount of anecdotal evidence of people who swear by the stuff. Of course there is nothing wrong with this, if it gives those individuals the edge they need to overcome injury or improve their training then great. The point is, that as far as I can tell, these effects are based on placebo, short lived, seem to mask the root cause of an issue or at the very least that Kinesio tape is no better than traditional types of taping.

The real issue is why are you taping in the first place? Utilising taping in sport should be done to help protect an area of weakness. Be that a joint or a muscle. As such you are trying to limit range of motion (ROM) or offer support and therefore you use a rigid tape. The taping is either compressing a joint, moving it into a less painful position or unloading hypertonic muscles (overly tense muscles). It is difficult to do this with elastic type tapes. It is also still a temporary measure to allow you to be active in the short term, not a cure (i.e. strapping a painful ankle before rugby). Realistically you shouldn’t be playing on it if you have pain and weakness, you should be rehabilitating it. You should be focusing on faulty postures to restore correct muscle length - tension relationships, reviewing the foods you eat, focusing on your training, performing the correct rehabilitation exercises to ensure the joint or muscle can support itself and doesn’t require the help of external support (i.e. tape!!). This is how you improve performance, not through taping.

Taping of any kind can be useful for those playing at a high level to aid in their recovery from injury as they are on contracts etc and are under pressure to play. It can also be used by physios and rehabilitation specialists as an aid to other treatment modalities. But it should not be relied upon as some sort of quick fix (“you’ll be fine, just strap it up”). Personally I believe too many people rely on tape in this way, rather than focusing on the underlying concerns of gross joint instability, poor posture and other muscle imbalances. This is not to say I don’t use tape, I have in the past and will do in the future, but the intent is always to use it in conjunction with further rehabilitation. In short, any taping should only be used as part of a clinical risk assessment, taking into account benefits versus costs to the individual (and in some cases the team as a whole), not just slap on the tape because “that’s what the pros do”.

Hope this was as enlightening for you reading it, as it was for me researching it.

All the best


Gregory Hunt


6.          References





[1] Williams S., et al. Kinesio in treatment and prevention of sporting injuries. Sports Med. 2012 Feb 1;42(2):153-64.

[2] Huang C., et al. Effect of the Kinesio tape to muscle activity and
vertical jump performance in healthy inactive people. Biomedical Engineering Online. 2011; 10: 70.

[3] Morris D., et al. Clinical effects of Kinesio Tex taping: A systematic review. Physiotherapy Theory & Practice. 2013 May;29(4):259-70. http://www.ncbi.nlm.nih.gov/pubmed/23088702

[4] Mostafavifar M., et al. A systematic review of the effectiveness of kinesio taping in musculoskeletal injury. Phys Sportsmed. 2012 Nov;40(4):33-40. http://www.ncbi.nlm.nih.gov/pubmed/23306413

[5] Compolo M., et al. A comparison of two taping techniques (Kinesio and McConnell) and their effect on anterior knee pain during functional activities. The international Journal of Sports Physical Therapy. 2013 April; 8(2): 105-110.

[6] Ayatar A., et al. Initial effects of kinesio taping in patients with patellofemoral pain syndrome: a randomized, double-blind study. Isokinetics and Exercise Science 2011;19(2):135-142. http://search.pedro.org.au/pedro/browserecord.php?recid=6153

[7] Paoloni M., et al. Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: a randomised trial. European Journal of Physical and Rehabilitation Medicine. 2012;58(2):89-95. http://www.tapingbase.net/sites/default/files/kinesio_taping_applied_to_lumbar_muscles_influences_clinical_and_electromyographic_characteristics_in_chronic_low_back_pain_patients.pdf

[8] Castro-Sánchez A.M., et al. Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: a randomised trial. Journal of Physiotherapy. 2012;58(2):89-95.

[9] Chang H.Y., et al. The Effectiveness of Kinesio Taping for Athletes with Medial Elbow Epicondylar Tendinopathy. Int J Sports Med. 2013 Jun 14. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/23771826